Medication-assisted treatment for substance abuse disorders is a proven way to help people beat their dependency on dangerous drugs, but surprisingly few health care providers are trained to use it.
UNM’s Department of Psychiatry & Behavioral Sciences recently won a three-year $450,000 grant from the Substance Abuse and Mental Health Services Administration to train medical students, and trainee nurse practitioners and physician assistants to precribe buprenorphine, a drug that blunts the high delivered by opioid drugs.
“We’ll have three years in which to establish a standing curriculum that is part of training for medical students, physician assistant students and nurse practitioner students,” says V. Ann Waldorf, PhD, an associate professor and chief of the Division of Community Behavioral Health, who is leading the grant.
Health care providers must receive a waiver from the Drug Enforcement Administration to prescribe buprenorphine (also known by the brand name Suboxone), Waldorf says, and they must undergo special training before they can receive the waiver.
Acquainting prescribers with buprenorphine during their training will likely pay off in terms of wider use of the medication in helping people who are struggling with addiction, Waldorf says.
“When they started looking at providers who were actively using buprenorphine to treat substance abuse disorders, if they were introduced to the idea of using Suboxone in training then they were more likely to pursue a waiver once they got out,” she says.
Students in UNM’s Physician Assistant program started receiving buprenorphine training last fall, Waldorf says. Forty-three second-year medical students also volunteered to take the training, she adds.
The new training includes both classroom and online learning, as well as time spent shadowing a provider to learn how to introduce it to patients as a treatment option, she says.
Waldorf credits colleagues Joanna Katzman, MD, and Snehal Bhatt, MD, for pursuing the grant. Katzman is director of the UNM Pain Center, which provides patients with tools and treatments to reduce their dependence on opioid painkillers, while Bhatt is medical director of UNM’s Addictions and Substance Abuse Program.
The use of buprenorphine is meant to complement behavioral and cognitive strategies to wean patients from their opioid dependency, Waldorf says.
“It is a medication-assisted treatment, not medication treatment,” she says. “The use of Suboxone is part of a biopsychosocial model that doesn’t look at addiction from a moral standpoint.”
UNM’s Physician Assistant program sends most of its graduates into primary care, and many go on to practice in rural or underserved communities where the opioid epidemic has been particularly destructive and treatment options are limited, says Lindsay Fox, PA-C, the program’s clinical and outreach coordinator.
“Already, we have seen students parlay this training into real-world, systemic change,” Fox says. “Students have been able to work with their preceptors in general surgery to help patients transition from buprenorphine in the pre-operative period so that they may receive appropriate pain management and then return safely to their buprenorphine regimen post-operatively with little discomfort.”